The issue of whether or not to test for the usage of human growth hormone has been a contentious topic of debate in the National Football League for quite some time now, but it seems to be making more and more headlines recently.

Left unsettled during the last collective bargaining agreement, the implementation of HGH testing in the NFL looks more and more inevitable as the league and NFLPA trade public barbs and the United States Congress looks to hold public hearings on the matter.

Major League Baseball had its steroid era, and the NFL looks to avoid a similar fate with HGH. NFL players and their union have continually blocked attempts by the league to create a system that will allow testing for the banned substance.

The Olympics and MLB have already added HGH testing, but NFL players have had a laundry list of reasons—many of them valid—that has precluded testing in the most profitable sport in America. Meanwhile, the league, as is par for the course between these two parties, has refused to budge on many of the players’ concerns.

The questions and issues surrounding HGH are numerous, complex and confusing. Tons of misleading information exists (even within the NFL community) as to what the drug does and the potential side effects that it could have. Why would NFL players even take HGH? What are the roadblocks to testing? What are the dangers of the drug?

To answer all these questions and more, Bleacher Report has talked to current players, former players, league and union officials and scientific experts in order to bring you everything you need to know about HGH and the NFL.

What Is HGH, and Why Would NFL Athletes Take It?

To get more info on HGH itself, I talked with Dr. Larry Bowers, the chief science officer of the United States Anti-Doping Agency (USADA). His staff bio credits him with publishing “more than 100 papers on drug testing and chemistry.” He also served as the deputy director of the drug-testing laboratory for the 1996 Summer Games in Atlanta.

First, let's look at some nuts and bolts of the substance itself. Dr. Bowers described HGH as “a peptide hormone that is needed for growth when it is secreted normally.”

HGH’s approved uses are for humans of smaller stature without normal levels of HGH or adults with documented hormone deficiencies. HGH’s purported benefits in terms of performance enhancement and anti-aging cannot be fully studied because taking the drug for those (or any off-label) purposes is actually illegal and could be incredibly dangerous.

While HGH is certainly a performance enhancer of some kind, it would be dangerous, illegal and unethical to run actual scientific tests on otherwise healthy athletes—especially in the quantities normally taken for performance enhancement. Therefore, athletes taking HGH likely rely on anecdotal evidence or, worse yet, sales pitches from companies selling the substance.

Players also take HGH to recover from injury, shed pounds and repair bone and cartilage damage, all without having the full scientific understanding of whether or not the substance actually accomplishes any of those tasks, how it does so and what the side effects could be.

Sources: SI, AP, British Journal of Sports Medicine

Dr. Bowers also pointed out that using HGH has its own risks associated with the drug’s side effects—diabetes, growth issues with joints (including arthritis) and negative effects on internal organs, including the heart. These are acceptable risks when one truly needs to take HGH, but the risk seems even greater when the reward of off-label usage isn’t a sure thing.

Although Dr. Bowers said that there is no scientific evidence for this, he agreed with me that one could assume athletes already at risk for those issues (as many former NFL players are) might see a compounded risk when taking HGH.

Thearon W. Henderson/Getty Images

Benjamin Watson

Benjamin Watson is an NFL tight end and a player representative to the NFLPA. According to Watson, he’s never taken HGH and doesn’t know of any NFL teammate who has. “Although people speculate about it,” Watson said, “it’s nothing I’ve ever seen. It’s just not something people would talk about.”

When asked how he would feel if opponents were taking HGH, Watson laughed and said that his wife would be the one to talk to about that. Players’ wives—and their families in general—are uniquely attuned to the dangers of the game. If a defender had the advantage of a PED and the person he was tackling didn’t, it would add another wrinkle to player safety in a game that is already brimming with player-safety concerns.

“We talk all the time about the integrity of the game,” Watson added. “Fans want to be confident that what they’re seeing is true sportsmanship. That’s part of what makes our game popular. We want it to be on a level playing field.”

The Specifics of the HGH Test

The proper way to test for HGH is through a blood test. This, at one time, was a sticking point for the NFLPA, as it sought to force the league to fund development for a less intrusive, urine-based test. However, as Dr. Bowers pointed out, HGH does not show up in urine in any significant amount.

He speculated that it might take “at least 10 years” to even attempt to develop a urine-based test, and even with that time commitment, it may never happen—meaning that such efforts would be a waste of both time and copious amounts of money.

Once blood is drawn and shipped to the lab, multiple tests are done on the sample. Interestingly enough, what’s being tested isn’t necessarily a certain level of the substance but a ratio of different types of the substance.

The human body naturally produces its own forms of HGH, while synthetic HGH is just one type, called 22-kilodalton. When the ratio is out of kilter in the human body (the term for this is monomeric), it shows that an athlete has been injecting himself or herself with the synthetic stuff.

In all, four distinct tests will be performed on a sample that has questionable ratios. Dr. Bowers puts the chance of a false positive at one in 10,000—roughly the same chance of being struck by lightning—saying that there is actually a greater chance for a false negative.

The test, as it currently stands, has already been used by the Olympics and is being implemented in MLB. It is a relatively new process—another sticking point for the NFLPA—as the 2012 Olympic Games were the first games that used this specific test, although other similar tests had been used previously.

The NFL would like to add the test but needs the support of the players union to do so. Technically speaking, the NFL and NFLPA already agreed to a test. What that test looks like, however, is still very much up for debate. From the current collective bargaining agreement (emphasis mine):

The parties confirm that the Program on Anabolic Steroids and Related Substances will include both annual blood testing and random blood testing for human growth hormone, with discipline for positive tests at the same level as for steroids. Over the next several weeks, the parties will discuss and develop the specific arrangements relating to the safe and secure collection of samples, transportation and testing of samples, the scope of review of the medical science, and the arbitrator review policy, with the goal of beginning testing by the first week of the 2011 regular season.

Welcome to 2013.

Oli Scarff/Getty Images

A tray at the London Olympics anti-doping lab.

Why Can't the NFL and NFLPA Agree on HGH Testing?

All of this seems pretty cut and dry, right?

Both sides claim that they are interested in a test, and the test is legitimate enough for both the Olympics and MLB. So why can’t it be used in the NFL? If NFL players truly want the level playing field that Watson talked about, there is already a test in place to make sure that happens.

Well, it’s not that simple, as matters between the NFL and the NFLPA never are. To try to sort the issues out, I talked with George Atallah, assistant executive director of external affairs for the NFLPA, and Adolpho Birch, senior vice president of law and labor policy for the NFL. Both men were kind enough to lay out their positions on the matter and answer plenty of questions as to why a deal can’t seem to be done.

Atallah cited the NFLPA’s desire for a population study of HGH levels (or ratios) in NFL players. The thought is that NFL athletes are singular among other sports. Calvin Johnson, Adrian Peterson and Robert Griffin III can’t be compared to archers and synchronized swimmers. The players want assurance that their financial well-being isn’t tied to a faulty measurement that doesn’t take their abnormal size and body chemistry into account.

Birch agreed that a population study has been the biggest impediment between the NFL and HGH testing. However, he added, “Every credible expert has said that a population study is unwarranted and unnecessary. A population study done before Olympic testing showed that the population study is unnecessary because the HGH test looks at a ratio."

Dr. Bowers, on his part, agreed with Birch—he is, after all, one of the aforementioned credible experts. He noted that the highest ratios of 22-kilodalton HGH in the Olympic population study weren’t found in the biggest athletes. Rather, it was cyclists, bobsledders and decathletes that produced the highest levels. Bowers also noted that even if size played into the equation, Olympic-level weightlifters would serve as natural size comparisons for NFL linemen, while non-linemen in the NFL would line up with plenty of Olympic athletes.

The NFLPA, however, isn’t willing to take the NFL or its experts at their word when it comes to the need—or lack thereof—for a population study, or, for that matter, the validity of the HGH test itself. The players want independent confirmation that the NFL is not foisting an HGH test upon them without dotting all of their I's and crossing all of their T's. Some sort of due diligence needs to be done in terms of peer review and methodology of the test. “That’s how science works,” Atallah said.

According to Watson, the NFLPA isn't getting that sort of information from the league: "[The] NFL has provided some of that some of the time. At times, we've been working together. At times, we haven't been—that's where we are now."

Both Atallah and Watson intimated their desire for a “fair” test. When I asked Watson what a fair test would look like to him, he responded, “A fair test to me is a player understanding the test, understanding the process, understanding that I have the right to challenge a test to due process. If I fail a test, I have the right to arbitration and I want to know what the punishments are."

Watson added that Bountygate has helped the NFLPA’s cause when it comes to the public perception of the role of Roger Goodell as judge, jury and executioner: “Everyone kind of saw what could happen...the detriment to not having arbitration.”

The NFL, of course, doesn’t want to give in to any of these checks and balances. Birch said again and again that the population study was not necessary, while Dr. Bowers speculated that the population study could skew further HGH testing if a significant segment of the NFL population were using HGH.

The league also believes that experts do not want to be a part of an unnecessary population study that would waste their time. Finally, the league and the USADA are reluctant that anyone vet the science behind a test because it could make the test easier to “beat.”

This is all part of the dysfunctional (yet completely expected) give and take between the owners and the players union. This is how negotiations are conducted, at least in the public eye, and no one gives up anything without getting something in return.

It Might Really Take an Act of Congress to Get HGH Testing in the NFL

Reps. Elijah Cummings (left) and Darrell Issa. Credit: Getty Images

When two sides can’t play nice, it’s always good to have a mediator between them to help the two work out their differences. If that fails, it’s even better to have someone who can knock both of them over the head.

Late last year, the Congressional Committee on Oversight and Government Reform held public hearings on the potential for HGH testing in the NFL. Chairman Darrell Issa (R-Calif.) and Ranking Member Elijah Cummings (D-Md.) said that their concern in this regard is based upon the role professional sports have in setting the practice for collegiate and youth athletes.

To those who know anything about politics, it’s more than amazing that Reps. Issa and Cummings agree about how to describe the weather, let alone an actual issue in our country. These men are rivals and set their agendas firmly against each other in virtually every other facet of their daily lives. Yet in regard to HGH testing, they seem to be on the very same page.

For the players union, the bad news is that the page they seem to be on is the exact same page as Goodell and the league owners.

[The NFLPA] say they need much more time to study this issue before doing what they agreed to do. To me, it seems obvious that the Players Association is simply running out the clock. Although they agreed to HGH testing, they are now trying to back out of the contract. Well, today we will have the opportunity to hear directly from medical experts and we will examine [their claims] under the bright light of science.

Should HGH be banned in the NFL?

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Should HGH be banned in the NFL?

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No

39.8%

Total votes: 337

It seems just a little off whenever Congress gets involved with professional sports, but remember that this is the same committee that held hearings on steroids in Major League Baseball. That effort, too, was a bipartisan oasis amid political turmoil. The faces in the chairs were all different, but the tenor of those hearings was almost identical—everyone knows this is a problem, so what are you as an organization doing about it?

Birch points out that Congress has always been involved: “They view it as a public-health matter. They understand the dangers of those drugs...realize the impact that [professional] athletes have on society. [Speaking on behalf of the NFL] We welcome that interest.”

Atallah believes that the NFL is using the congressional hearings (as well as other methods) to pressure the NFLPA into accepting a testing proposal outside of the normal collective bargaining process: "This whole game is about them trying to leverage their way into the test without giving anything in return.”

Both Issa and Cummings have a history of being hard on drugs, and both have personal stakes in issues like this, as they work with athletes in their own districts with their own steroid-prevention programs. They believe that the NFL needs to set the tone for athletes everywhere with a clear line in the sand against any performance-enhancing substance.

NFL Needs to Take a Stand as Role Models Against PEDs

Win McNamee/Getty Images

NFL Hall of Fame linebacker Dick Butkus has a personal stake in this issue as well. He runs the “I Play Clean” campaign in an effort to teach young football players that pharmaceutical help is not necessary to excel at the highest levels of the game.

Butkus was asked to testify before the House as part of its recent HGH hearings, and he sat down with Bleacher Report to discuss his testimony as well as his campaign against performance-enhancing drugs.

“Kids look up to these players,” Butkus said. “People try to claim, ‘I’m not a role model.’ Bulls***. Yes, you are. I didn’t want to accept it, but eventually I did. Eventually you have to look beyond yourself. This is the least I can do to give back, and there’s a need for it. Sports have been good to me.”

Butkus admitted that he testified before Congress for “selfish reasons.” He started “I Play Clean” eight years ago with a parent who lost his son to suicide due to steroid use. From there, Butkus couldn’t ignore the scientific evidence building up around PEDs. As he dug into the issue, he also couldn’t ignore the fact that many young players didn’t seem to have any idea about the dangers of PED use.

Butkus also admitted that HGH isn’t a likely problem among high school athletes. However, it could be: “We didn’t know what steroids were when I was playing. ... Steroids are easy to come by now and HGH is too expensive. Kids are talking about it—they’re having that conversation. We shouldn’t think they’re sitting idly by.”

Watson agreed with that assessment, saying, "I have a younger brother in college. When he was in high school—the things that high school players were doing and exposed to weren't even an option when I was in high school! We are role models. We want kids that are playing the game to be working hard, lifting weight, nutrition, all that. We don't want kids thinking that they need to cheat to get ahead."

It’s important to remember this isn’t just about sportsmanship. During his opening remarks to the congressional hearing, Rep. Cummings laid out the potential dangers of HGH use, including "hypertension, diabetes, arthritis, bone spurs, spinal stenosis, disfigurement and cardiac dysfunction."

Those are the same dangers Dr. Bowers outlined—dangers that could be compounded by all of the other health issues that NFL players already deal with. For the next generation of potential football players, taking those risks earlier and earlier seems even more dangerous.

Even if every other argument against HGH use were to fall short, everyone seems to agree on this: No one really knows for certain what this substance does to the people who inject themselves with it. If HGH use continues unchecked and reaches the younger levels of the sport, numerous health issues could endanger the future of the game.

With that in mind, HGH testing in the NFL needs to happen sooner rather than later. That means the NFLPA and the league need to come together on a reasonable test, arbitration process and appeals process as soon as possible. For the sake of the game, these two sides need to come together one more time—just as they did during CBA negotiations—and figure out a solution that is amicable to both sides.

All quotes, unless otherwise noted, were obtained firsthand by the author.

Michael Schottey is the NFL National Lead Writer for Bleacher Report and a member of the Pro Football Writers of America. Find more of his stuff at The Go Route.